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Patients with physical problems related to the use of alcohol or drugs often present to general hospitals in an unplanned, emergency fashion. In 2005, the Kerr report concluded that fundamental changes were needed in our approach, shifting the emphasis from a reactive to a more proactive, prevention-based model in the treatment of acute medical conditions. We studied patients who had at least one alcohol- or drug-related emergency admission, whose most recent admission was to Aberdeen Royal Infirmary and who, using the Scottish Patients at Risk of Re-admission and Admission (SPARRA) All Ages Tool, were thought to be at high risk of further emergency admission. We examined data sets derived from the National Health Service National Services Scotland Information Services Division, a Liaison Psychiatry database, data from the local psychiatric Patient Information Management System and data collected by the hospital alcohol liaison nurse to examine this group of patients further and consider the scope for any future intervention. Patients who have an alcohol- or drug-related emergency admission to the general hospital are at increased risk of re-admission. A substantial proportion of these patients has come into contact with the psychiatric services, often attracting a substance misuse and/or personality disorder diagnosis. A significant proportion also presents in the context of self-harm. In conclusion, this group of frequent hospital attenders may be difficult to engage but may benefit from more proactive intervention, a more joined-up management approach and the development of an enhanced general hospital alcohol liaison service.